Recent News and Events

by Cuyler Hudson, PT, DPT

Posted in Blog.

June 11th, 2019

Is Your Brain Making Your Pain Worse

           On the surface, it sounds like the laziest cop-out ever to hear from your MD or PT, “I don’t know what else to do, let’s just say it’s all in your head.” However, as the topic of pain science continues to be studied, certain truths about how the brain creates pain have been uncovered. This has shone a light on how pain, and specifically chronic pain, may be created by more than just damage to a body part.


           There are 3 important truths we need to understand about pain science. The first is that pain does not provide an accurate measure of the state of the tissue. There are a plethora of studies, in both animals and humans, that have consistently demonstrated that with the same stimulus, the response in the brains pain center (nociceptors) varies considerably from person to person. Furthermore, there is no relationship with how stimulated your “pain center” is, and how much pain the person perceives he/she is in. This is all to say that the same injury will cause a different level of activation in the brains pain center, and different levels of pain a person will say they feel.


  1. Pain does not provide an accurate measure of the state of tissue
  2. Pain is influenced by your body, your brain, as well as social factors
    1. Attention
    2. Anxiety
    3. Expectations
  3. The relationship between pain and the state of the tissue becomes less reliable the longer pain persists


         Second is the concept that pain is influenced by your body, your brain, as well as social factors. This goes back to the old stories of a soldier shot in war that doesn’t feel it, or a football player who breaks his finger and isn’t aware until after the game. While the research in this area is less clear, it is apparent that a few factors have big influences over the perception of pain. The first is attention, while most studies suggest that the more one focuses on pain, the worse it gets, there are some studies which suggest the opposite. The second is anxiety. If the mere fact of getting injured or feeling pain gives you anxiety, you are more likely to feel more pain than a person who reports he/she did not feel anxious. Lastly, expectation can affect pain in a big way. It’s been repeatedly shown that if something happens to a person, and the pain they feel is more intense than they expected, pain will increase. However, if for the same stimulus, the pain they feel is less than they expected, pain will decrease. This also is responsible for the placebo phenomena. In general, if you give a person a drug and tell them it will make their pain better (even if it’s just a sugar pill), it will decrease pain.


           Lastly, and perhaps most importantly, is that the relationship between pain and the state of the tissue becomes less reliable the longer pain persists. As with anything in your body, your nervous system is constantly changing. If you have a “pain nerve” that is constantly firing over a period of months or years, the pathway of that nerve to your brain becomes much more easily activated. It is essentially always ready to fire because it is so used to firing. This results in a much more sensitive area, where things that used to hurt begin to hurt more, and things that used to not hurt are now painful.


           So how does this help us? Not to be too cliché, but knowledge is power. It’s important to understand how long tissue healing takes and the typical response to an injury. If you feel as if an injury is taking forever to heal despite doing all the right things, there is a high chance that your brain/nervous system is playing a role in your pain. If you are well past the normal time for tissue healing, it is likely that the tissue of your injured body part is healed. This means that it is indeed safe to return to certain activities, although this may consist of running/playing through some pain. The only way to desensitize neurons is to prove to your brain that the tissue is healed by putting it through its paces (gradually of course) without further tissue injury. Although this might also take some time, it may be the only way to take yourself from chronically injured to enjoying your recreation once more

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